Cancer research and clinical trials

During the month of June on this blog, I got annoyed not once, but twice. First, I got annoyed at Sharon Begley for a truly annoying and evidence-free (other than cherry-picked anecdotes) broadside against the NIH for its “culture of caution” that, according to her, is largely responsible for the “lack of progress” against cancer over the last 38 years since President Richard Nixon declared “war on cancer.” In essence, Begley blamed the need scientists have for publishing in the highest impact journals they can get their manuscripts into for “delaying” cures or, as I put it, “keeping teh curez from teh sick babiez!!!” To her, the emphasis at the NIH on basic research is keeping translational research from actually being translated to patients. Unfortunately, Begley appeared not to understand that translational research requires a healthy pipeline of basic science recoveries to feed it or that the NIH actually does emphasize translational research. Mike the Mad Biologist also pointed out that Begley appeared to be mistaking a symptom for the real problem.

A couple of weeks later, Gina Kolata of the New York Times picked up the gauntlet and ran with it in a similar direction, only with a different twist. In essence, Kolata, using a few cherry-picked anecdotes and no objective evidence or study, blamed instead the way grants are awarded. To her, it was all those nasty scientists who demand, you know, evidence to support grant applications and can’t see the vision behind “high risk” research. Of course, far be it from me not to admit that the NIH peer review system is all too often risk-averse, but the level of caution is more or less inversely proportional to the level of funding. Also, what non-scientists (and a lot of scientists) seem not to realize is that these “transformative” and “risky” ideas that paid off are (1) far outnumbered by risky ideas that never pay off and (2) usually only recognized as transformative in retrospect. As we used to say in residency, the retrospectoscope’s vision is 20-20, but at the time scientists are trying to pick between “risky” projects, there is often no good way to distinguish between multiple ideas that seem good but maybe only one (or even none) of which will ever actually result in a major improvement in cancer treatment.

Not long ago, at a meeting of an advisory group established by Congress to monitor the war on cancer, participants were asked how to speed progress.

“Everyone was talking about expanding the cancer work force and getting people to stop smoking,” said Dr. Scott Ramsey, a cancer researcher and health economist, who was participating in that January 2008 meeting of the President’s Cancer Panel. “Lots of murmurs of approval.”

Then it was his turn.

The biggest barrier, in his opinion, was that almost no adult cancer patients — just 3 percent — participate in studies of cancer treatments, mostly new drugs or drug regimens.

“To me it was obvious,” Dr. Ramsey said. “We can’t improve survival unless we test new treatments against established ones.”

The room fell silent.

“It was one of those embarrassing moments,” said Dr. Ramsey, an associate professor at the Fred Hutchinson Cancer Center in Seattle. He had brought up the subject he said no one wanted to touch.

Forty years after President Richard M. Nixon declared war on cancer, death rates have barely changed. “Why aren’t we getting cures?” Dr. Ramsey said. “This is one of the biggest reasons.”

Right on! I can tell you that this is a huge problem. I’ve now been on the faculty at two major NCI-designated comprehensive cancer centers in my career. Yes, this is anecdotal, but at both of them keeping our clinical trials going by accruing enough patients has been a major concern. It’s one of the criteria by which we judge our clinical research programs, and we absolutely can’t make any progress against cancer without well-designed clinical trials that accrue enough patients to have the statistical power to tell if a new treatment is working better than the standard of care. Overall, the article provides a good explanation of why there are such problems. The problems are at all levels, including patient concerns, roadblocks to physicians enrolling patients in clinical trials, and systemic issues. Many of us in the oncology field are stymied and frustrated as well, because we believe that clinical trials represent some of the best medicine patients can receive. Nowhere else is care so closely supervised, do deviations from protocol need such a detailed explanation, or do adverse events result in as much reporting.

There are many patient concerns and misconceptions out there. One of the most common of which is the fear of getting a placebo. If there’s one thing I want to emphasize right here right now, it’s that placebos are rarely used in cancer clinical trials. The far more common design is to add the new drug being tested to the existing standard of care or to compare the new drug combination being tested against the standard of care. Another concern, which is more difficult to overcome, is that patients do not like the loss of control that comes with joining a clinical trial. The randomization process requires that the patient agree to accept its result, which means that any subjects in a clinical trial might be given standard of care or might get the new drug. Those of us involved in clinical trials know that one of the motivating factors for entering a clinical trial is the hope of receiving a newer, more effective drug; they don’t want the “old” drug. Of course, the novelty effect leads most patients to tend to downplay the potential risks of a new drug and overestimate the potential benefits, but, distorted assessment of risk-benefit ratio or not, we as clinical researchers can’t ignore these concerns. Not surprisingly, it is patients who have the worst disease and the bleakest prognosis who are usually the most willing to “try anything” and sign up for even the riskiest clinical trials, namely phase I trials, sometimes called “first in human” trials.

To give you an idea of how difficult it can be to persuade a patient to accept randomization, look back 30 years or so to breast cancer clinical trials. This was when lumpectomy was coming into vogue and surgical trials were being done to compare modified radical mastectomy (mastectomy plus removal of the lymph nodes under the arm) with lumpectomy and axillary dissection followed by radiation therapy. Imagine being a patient being asked to accept randomization to either losing your breast or not. Never mind that we didn’t know at the time whether the “lesser” surgery of lumpectomy and radiation therapy would be as likely to cure the disease as mastectomy. Giving up that choice required a beneficence that few can manage, and it is doubtful that such a trial could be done today.

There’s yet another issue that concerns me because I work in a highly urban cancer center. Among some groups of African Americans, there is a huge mistrust of doctors. It’s not entirely unjustified either; well do many remember the Tuskegee syphilis experiment and other abuses. Many of these patients are very resistant to signing up for a clinical trial because they honestly believe that human experimentation will be as exploitive of them as the Tuskegee syphilis experiment was. It’s very hard to overcome this at times, but it’s important to try. The main reason is because African American women tend to have a higher incidence of a more aggressive form of breast cancer and thus a lower survival rate and younger age at diagnosis.

From the physician side, there’s a huge impediment to enrolling patients on clinical trials. Not all physicians can design and carry out clinical trials, but many of them who are not affiliated with major academic medical centers can still sign them up for trials. The problem is that there are few incentives, other than a desire to help advance the field, to promote more physicians signing up patients for clinical trials. First off, there is no reimbursement for it. Before the first patient is considered for a trial, it takes a lot of work to get a trial approved by an institutional review board (IRB), as well as a significant infrastructure in order to monitor patients for adverse reactions and response to therapy. To sign a patient up is also a lot of work. A lot of work. It takes a lot longer to explain to a patient a clinical trial and obtain informed consent than it does to give standard therapy, and there is no additional reimbursement. Moreover, unlike conventional chemotherapy, oncologists are not reimbursed more. They lose money:

For 15 years, Dr. John M. Rainey at Louisiana Oncology Associates in Lafayette did his best to enroll patients in clinical trials. He believed in research and thought doctors like him should do their part. But he finally had to stop. Every study was costing his group a few hundred dollars to $1,500 and the bureaucratic requirements were getting out of control.

“When we put a pencil to it, it didn’t make economic sense,” Dr. Rainey said.

First was the institutional review board, the committee that reviews the trial to make sure patients are protected from harm. Every time a study patient had an adverse reaction, every participating medical center had to notify patients and respond to the review board. Many reactions had nothing to do with the drugs, Dr. Rainey said, and instead were related to the patients’ illnesses.

“It became a hassle factor,” he said. “We didn’t have the manpower.” One of the five doctors in the group was spending three to five hours a week filling out forms.

“You could see five or six or seven patients in that time,” Dr. Rainey said.

Few private oncology groups have the resources or manpower, and, even in large academic centers, coming up with the resources to support the expensive infrastructure and bureaucracy necessary to run clinical trials can be a problem. True, the NIH and other sources fund clinical trials, but even at large cancer centers signing patients up for clinical trials can often be a major challenge, logistically, financially, and in terms of persuasion.

This brings me to systemic issues, which include issues of science. As the article mentions, a lot of clinical trials are too small to produce definitive answers and some are redundant. Many end up closing because of insufficient accrual. Last fall, I saw a depressingly amazing talk by Dr. David Dilts, PhD, MBA of the Center for Management Research in Health Care. He pointed out how inefficient and crude our current clinical trial mechanism is. Indeed, so impressed was I that I still have some of my notes. It turns out that 29% of clinical trials never accrue a single patient, while 31% accrue less than five. Overall 63% of clinical trials fail to reach their accrual target, and it costs an institution between $700 and $4,000 month to keep open each low accruing trial. The system is hugely inefficient. Worse, the emphasis in the health care reform bill wending its way through Congress right now on comparative effectiveness research will only make the problem worse. While such research is useful from a practical standpoint to determine whether drug combination X is better than drug combination Y or to determine if dosage schedule A is better than dosage schedule B, it will not result in breakthroughs. Quite frankly, as useful as it is from a practical standpoint, from a strictly scientific standpoint, comparative effectiveness research is about as uninteresting as it gets.

It’s toward the end of the article that Kolata goes a little off the rails. Given the structure of a typical story, it’s not very satisfying to present just a problem, as this story does up until now. It’s far more satisfying to present a potential solution, and this is what Kolata does:

Donald Berry, a statistician at the M.D. Anderson Cancer Center in Houston, wants to use resources more efficiently. To do so, he designed a new sort of study to test experimental drugs for breast cancer.

The study, starting this fall, is a departure from traditional notions of drug testing and cancer treatment.

Participants will be women who are newly diagnosed with breast cancer and at high risk that it will spread in their bodies.

Ordinarily, women with breast cancer have surgery first to remove the tumor in their breast and then have chemotherapy. The problem with removing the tumor right away is that it can take 5 to 10 years to know whether an experimental drug killed any remaining cancer cells. It is easier and much faster to assess an experimental drug’s effects on tumors that remain in the body. So in this study, women will get standard chemotherapy and experimental drugs first. Researchers will do MRI scans to see whether the tumors are responding.

Then, six months later, surgeons will remove the tumor or, if the tumor is gone, tissue from where it used to be, to determine how the cancer responded to the drugs.

The idea of leaving a cancer in place for six months can sound shocking, even dangerous. But cancer researchers say it actually makes no difference whether chemotherapy comes before or after surgery.

The study involves the use of a contrast-enhanced breast MRI for the evaluation of locally-advanced breast cancer patients undergoing neoadjuvant treatment. The I-SPY study aims to correlate MRI results with molecular markers to identify the right surrogate marker for early response.

The I-SPY informatics effort involves providing informatics support for the I-SPY trial. This involves the integration, and analysis of diverse data types including clinical, MRI imaging, gene expression, Comparative Genome Hybridization (CGH), immunohistochemistry (IHC), Fluorescent In Situ Hybridization (FISH), and cell lysates throughout the breast cancer treatment cycle. By providing an integrative platform designed to correlate molecular data with MRI patterns, study researchers will be able to more effectively identify surrogate markers for early response which will ultimately result in more effective therapies for breast cancer patients.

It’s a very impressive “big science” project, the very sort of thing that the nominee to be the new director of the NIH, Francis Collins, is known for promoting. I’m of a mixed mind on this. On the one hand, there could well be major efficiencies to be had in sharing data. Also, our current methodology for predicting response to chemotherapy is crude at best, even with innovations such as the Oncotype DX finding their way into clinic. This question has been the Holy Grail of oncology for a very long time–decades even. While the I-SPY trial could provide us with a large amount of new information, unlike how it is portrayed in Kolata’s story, I highly doubt it’s the “definitely the answer” to getting answers with fewer patients. The reason is simple: The more markers for response to chemotherapy, be they molecular biomarkers, MRI, or other imaging studies, the more permutations of potential therapies will be. The more genomic subtypes of breast cancer, each requiring a different treatment, again, the more permutations. That’s always been the problem with “personalized medicine.” Validating the correlations between various combinations of biomarkers and response to therapy has always been problematic. Don’t get me wrong; trying to figure out these questions the traditional way would have required ridiculous numbers of patients. Moreover, initial tumor response doesn’t always correlate with a prolongation of survival. True, lack of initial tumor response correlates with a lack of improvement in survival due to treatment, but correlating tumor response to survival has always been dicey.

Another thing that has to be understood is that the final trials, phase III trials based on the results of earlier parts of the I-SPY trials are not likely to take any less time than any other phase III trial. The reason is that, unless the differences in survival between the new treatment group and the standard of care group are truly dramatic, it will still take between five and ten years to see them definitively–particularly if only 300 patients are used in these final trials.

Human subjects and human tissue are the most precious resources in translational science. All the careful and elegant preclinical science in the world, with its careful biochemical and genomic studies, cell culture correlates, and animal models, goes for naught if the ultimate result doesn’t translate into an effective therapy in humans. The only way to validate a therapy that has managed to jump through all the preliminary preclinical hoops is to test it in humans and follow the responses that occur in human tissue. Not only can such studies tell us whether a new therapy works or not but they can reveal the biology behind the disease and its response to therapy. To complicate matters, all of this has to be done under the highest scientific and ethical standards that protect patient autonomy and minimize the risks of harm to research subjects. It’s no wonder that efforts are under way to use fewer human subjects. Who knows? I-SPY may even be a major advance. I just don’t think it will be a panacea for this problem, and that’s what Kolata seems to be implying that it is.

39 Comments

While I don’t believe that the US medical care system can’t be improved, or that NIH grant funding is perfect, both long term data for the US, and comparative data (US vs. EU) on cancer survival don’t support the criticims of the authors. What is sad is that I found the info, below, within a few minutes using very simple internet queries. You’d think that “journalists” writing “analysis” would try to do better than what I can quickly find using public source information:

âThe five-year observed survival of men with prostate cancer has increased steadily from a low of 45.1% for men newly diagnosed in 1973 to 66.9% for men newly diagnosed in 1990 (Figure 5.1). The average annual increase was 1.3. The ten-year observed survival rate has also increased over time, but at a slightly slower pace. The ten-year observed survival has increased by about 0.9 per year from 21.8% for men newly diagnosed in 1973 to 32.2% for men newly diagnosed in 1985.â

[and]
Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States
By Zosia Chustecka, Medscape Today (Aug. 22, 2007) at: http://www.medscape.com/viewarticle/561737
âThe age-adjusted 5-year survival rates for all cancers combined was 47.3% for men and 55.8% for women, which is significantly lower than the estimates of 66.3% for men and 62.9% for women from the US Surveillance, Epidemiology, and End Results (SEER) program ( P < .001).
Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this "probably represents differences in the timeliness of diagnosis," they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.â

Science and logic are not needed to major in journalism. At the risk of sounding condescending, there are very few if any “science journalists” without advanced science degrees (M.D. or PhD) who seem capable of understanding the nuances of scientific reasoning or able to fathom the complexities of controversial subjects. They try to distill the subject down to simple conclusions ignoring the tremendous uncertainties which exist. There is a tendency to blame political or economic motives as the reason for scientific controversies when they don’t understand the debate. Sharon Begley is, by far, one of the worst in major print media.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

First, Matilda: it’s my understanding that is because so few treatments are FDA approved for use in juvenile populations, only adults.

(Caveat, I work in the contract pharmaceutical research industry and have for eleven years)

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

Recruitment is the only valid hurdle mentioned in this article. This is, again, true for all clinical studies but especially for terminal illnesses such as cancer. But patient travel is not a factor — patients are compensated for participation, including all travel expenses (I’ve worked on studies where patients were flown to their study sites at sponsor expense, including meals and hotels). Often recruitment is difficult to impossible because the “ideal” patient needed for a given trial protocol doesn’t actually exist. That’s what people in my industry bang our heads against walls about the most — sponsors (pharmas, biotechs) whose expectations have no basis in clinical reality.

I understand that there is a great deal of paperwork involved in an oncology trial, however, this is true of EVERY clinical trial, be it oncology or acne. So this argument does not hold up. If this were the biggest obstacle, noone would participate in them.

And if you don’t have the time or personnel to do this paperwork you won’t be inclined to try to sign the patients up.

Second, the argument of cost to the investigators is also invalid. First of all, IRB and all other costs are fully reimbursed by the study sponsor, no investigative site is out of pocket. Clinical trial budgets are negotiated on a site-by-site basis and agreed upon by all parties long before patients are enrolled. If investigative sites are losing money, they are either negotiating the budgets incorrectly or are doing the wrong type of trials.

You are clearly in the pharmaceutical industry, and your view appears fairly narrowly focused on pharma-sponsored trials. Maybe that’s true for pharma, but for the vast majority of non-pharma-sponsored clinical trials it is most definitely not true in that you count only direct costs. It takes much, much longer for a doctor to explain a clinical trial to a patient, get consent, and the patient signed up than it does for standard care. Let’s go back to this quote from the article:

For 15 years, Dr. John M. Rainey at Louisiana Oncology Associates in Lafayette did his best to enroll patients in clinical trials. He believed in research and thought doctors like him should do their part. But he finally had to stop. Every study was costing his group a few hundred dollars to $1,500 and the bureaucratic requirements were getting out of control.

“When we put a pencil to it, it didn’t make economic sense,” Dr. Rainey said.

First was the institutional review board, the committee that reviews the trial to make sure patients are protected from harm. Every time a study patient had an adverse reaction, every participating medical center had to notify patients and respond to the review board. Many reactions had nothing to do with the drugs, Dr. Rainey said, and instead were related to the patients’ illnesses.

“It became a hassle factor,” he said. “We didn’t have the manpower.” One of the five doctors in the group was spending three to five hours a week filling out forms.

“You could see five or six or seven patients in that time,” Dr. Rainey said.

In any sort of non-academic setting, that extra time can be a deal breaker, and I have yet to see a sponsor that pays for that extra time–pharma or otherwise. The funds negotiated through pharma go to pay for the clinical trials infrastructure, such as the IRB, the CTO, etc.–and that’s only for big academic centers running the trial. The doctors don’t see it, and they’re still in most places expected to see their usual share of patients. Moreover, the funds don’t necessarily trickle down to the community oncologist interested in signing patients up (and, let’s face it, the vast majority of cancer care in this country is done not by academic cancer centers, but by community oncologists and surgeons).

Saying that these community oncologists should have negotiated a better deal is putting the blame in the wrong place.

Re: #2
Wfjag, you might be misinterpeting the prostate cancer survival comparison between US and Europe. It is true that post-diagnosis survival in the US is much longer due to extensive PSA screening as stated in the abstract, but that is mostly (or, arguably, entirely) due to the so-called “lead-time”: if screening detects a cancer 2 years earlier than it would be detected otherwise, then the post-diagnosis survival is increased by 2 years even if earlier treatment does not provide a survival benefit. The simplest way to increase prostate cancer survival is to “diagnose” every man with prostate cancer at birth. Suddenly these “patients'” 5-year survival would be above 99%!

The point is that you cannot compare survival rates of populations with very different screening practices.

In some situations a trial is a good way to get around the limitations of your health coverage.

The state we live in requires insurers to cover treatment in trials. This often means someone in a managed care plan who might otherwise have a garden-variety oncologist administering treatment can take advantage of higher-powered research and care facilities by signing on.

That’s not to say that high-powered institutions will provide care that makes everyone happier, but if you think you want bigger guns on your case a trial is one way to get there.

Gina Kolata’s name always rings a bell for me with an (in)famous New York Times Sunday front page story in 1998 about the late and great Judah Folkman’s work. As I recall the article featured some daft comment from Jim Watson about Folkman “curing cancer in two years”. The day the story appeared, shares of the company that had licenced Folkman’s endostatin went through the roof.

[I just found the Kolata article is still online here – the wonders of the net]

Kolata took a lot of flak for over-selling the story, especially after a rumour did the rounds of the scientific world to the effect that Kolata had a book deal lined up, with a big advance, to write a book on the search for cancer treatments – though no such book appeared (she wrote one the following year about the 1918 flu pandemic).

Anyway, it was a big fuss at the time. It was even “credited” in places with setting angiogenesis research back through having given it too much hot press too early, thereby promoting a certain cynicism about angio stuff. I guess Orac would probably remember all this better than I, since he may well have been doing angiogenesis-related research the time.

The author mentions the difficulty of “persuading” patients to accept randomization. Further, he says that, in most oncology trials, randomization is between standard therapy and standard plus experimental.

I believe that a health care provider offering randomization requires a state of equipoise, or complete indifference, between the treatments being offered. Otherwise, his/her concern for the patient would dictate that he offer the treatment he/she thinks superior. If the patient prefers the standard, and the investigator is indifferent, why should one try to persuade?

Tom wrote: I believe that a health care provider offering randomization requires a state of equipoise, or complete indifference, between the treatments being offered.

In our survey of online lymphoma patients, Randomization was indeed cited as the main reason for declining to participate in a considered study. It’s uncommon when patients and treating physicians (rightly or wrongly) do not have an opinion about which is superior …

So it seems that the more reliable path to the approval of new agents or protocols for cancers will be in the refractory setting, which is not the best of circumstances for curing patients or having an impact on survival, but at least does not require randomization to show strong evidence of clinical benefit.

Investigators, regulators, and sponsors seem too often self-engaged regarding the study design and endpoints – important, yes … but time must be taken to think about and communicate to the patient (and treating doc) regarding the rationale of the study as a treatment decision compared to standard options.

Is anyone else frightened by this conversation?
the detection vs incidence figures via PSA are rarely clearly defined
and the decade death numbers for many cancers remain at the surgical levels of the sixties

A note on Kolata’s claim that “Forty years after President Richard M. Nixon declared war on cancer, death rates have barely changed.” The fact is, death rates are down about 15 percent since the early 1990s. She’s ignoring that and doing some statistical sleight of hand to make her case. The Times published a letter to the editor from the CEO of the ACS the last time she made the claim, after her April piece:

Orac: To her, it was all those nasty scientists who demand, you know, evidence to support grant applications and can’t see the vision behind “high risk” research.

There’s a difference between the kind of evidence required to draw a conclusion and the kind of evidence required to support a new idea. NIH reviewers typically apply the standards for conclusions to grant applications, which is strangling new ideas.

A common saying — said even by scientists who obtain NIH funding — that “you have to have done the work in order to get funding to do it” is evidence of my assertion. Even SBIR grants, which are defined as being “high risk projects,” suffer from this problem.

NIH should be funding a mix of risky and non-risky ideas, rather than sticking to one type.

Obviously, NIH grant review isn’t an isolated problem, but the very high degree of risk aversion that dominates there is a reflection of similar problems elsewhere.

As an epidemiologist in my former life, I fall down on my hands and knees with gratitude for the people who agreed to be recruited for clinical studies. When I was a lowly research assistant, I was the bunny who had to present enrolment in a study as both good for personal health, and good for medical knowledge as a whole.

You sick people have entirely, painfully, destroyed my life through the use of freemason/cia charity fronted agencies, destroying my life. I had a promising future ahead of me. I was the kindest nicest person in the world. You destroyed my life and my future. Ten years of grave pain and suffering at your hands. God damn you all to bloody hell and destruction for the job you to to betray your own kind to get a paycheck and get ahead. You succeed on our bloodied backs and make damn sure you don’t forget or disregard our pain and great suffering from it. It is VERY PAINFUL AND WE ARE GOING TO DIE PAINFULLY BECAUSE OF YOU. Because…of….you.

I am the person who fought like bloody hell in grave poverty you placed me in and got that Pope New Canon laws to stop you, “NO HUMAN EXPERIMENTATION”, “NO GETTING TOO RICH”. Hear the cries of all the human sacrifices to your science that die every year at your hands, because you do this line of work. NEVER EVER Forget, while you are dining in fine restaurants or working in a lab and collecting paychecks driving nice cars, we barely have anything because you exist. We die, because, you exist. Oh, it’s for the sake of the future? What future? What good could come from this future of slow torture murder and fake schizophenia to hide your crimes to humanity.

Oh, I am very sure you thought this all out. I am most assured that you are the most sick people of all diluded to not pay attention to the small details of your success, as they lay dying and suffering and discarded. We are destroyed for life because of you poisonous sickened retards. You think you are so damn smart, I ask you, where is your brain? WHAT kind of beast would do this to their own kind? YOU! That’s who.

All I asked you to do was stop it and you continued.
You deserve this life, I do not and neither did two of my sweetest friends. You have no idea who they choose. They chose me, because I didn’t want to date an ex navy seal, naval assassinator trained, because he was caught in multiple lies, and dated 5 girls at the same freaking time and tried to kill me. I broke off dating him and he didn’t want anyone else to get me so he had me placed on this hitlist.

My girlfriends and I were some of the nicest people on this planet and what you did, was change all that. I am ashamed to be this close to you. I’m ashamed that you get to use my body as your tool. The sickest part about this, is I have been completely financially destroyed by the military and covens that are hired for black operations to help you pieces of crap.

Next, I go to fight for my rights to get free and they want to lock me, up? Me?! I have evidences and the police protocols keep me from proving your crimes to me via these street people. They hire gangs to help. Piece by piece, I have had entire cars totalled by your group, front and back. I have had complete destruction piece by piece, as I lose employments due to crazy crazy reasons. I move 1-2 times a year just to try to get one month of freedom from being harassed and abused by your street gangs working to help me keep from living well to defend myself from these crimes. I cry nearly every night from the pain and suffering of these groups that help you destroy my character so you can hide the crimes you do to humanity.

Can you live with yourselves? You have, so, I assume, we don’t matter. Well, we matter more than you. I will stop at nothing to become free and free my friends. It’s aweful funny how all three of my friends came down with the same purposely destroyed lives. I have enough evidence now to sink your ship, but, I promise you, when it sinks and it will, it won’t be from courts, as you and I know the entire system is based on fraud of justice and they would help you hurt your victims more.

So, yes, I’m the victim of your human betrayal and crimes and countless fraud protocols in the DSMIV to get anyone charged with mental illness and dilusional issues.

Well, people, I promise you this, I’m not done here. You are going to have to kill me because I’m going to bring you all to justice, even if my fingertips and flesh bleed clawing my way back out of the nasty painful life and living grave you put us in, alive, to do your sick human experiments on.

Try letting the living live instead of you people hurting them and destroying their lives. You don’t even want to know how they get little kids. They target people that are in poverty. Remove good parents from their kids and access them by ripping their good families apart. In America, you have to be really lucky not to become their victims. I promise you that.

I had a DOD and FBI clearance. I was doing well in life, just about to buy a house on the water and start enjoying life with my friends after working so hard to make it. You took all my dreams away by existing in the fashion you do.
You know how I became in poverty, running for my life trying to escape the black ops person who wouldn’t stop trying to kill me.

Thank you, for taking not only my life, but, countless other, friends of mine, and making a temporary pain, permanent and destroyed. While you receive awards and praise, remember, we are being demeaned, destroyed and told we are going to die every single day of our lives and even spit on, cursed and treated like crap, then, told we are imagining things and that no one will ever believe the truth. How’s that for a suck lifetime stolen by you. THIS is the reality of your success for us. You succeed, we endure pains you can’t fathom. They should be sending us the checks you get for what we endure. But, no, that would be just. Instead, we get destroyed and get to suffer purposeful pain inflictions for your tests using us. Slavery was a much better chance at life for us than this existance and shame on you for thinking this is acceptable. You are all the lowest forms of life for doing what you do to human life. For every successful thing you do, you torture and kill us good people with your betrayal to human life.

I hope you stop one day, when you wind up staring down at your own daughter’s corpse, the way my dying father will not get to. My father was the sweetest kindest most gentlest man. I won’t be there for him to say goodbye in his most frightened moment of his life: death…because you pieces of crap for life did this to me and it would kill him to know what was really going on (and imagine how horrible he’d feel if he was lied to and told that his daughter was mentally ill, just to hide your sick secrets) better he never knows me again…it will save him serious pains and suffering. If he ever knew what you sick people do to us, you would ruin any niceness that existed.

I never would have thought of hurting another human being and you do it so easily. You think you help people? You kill us to get your prize. Go kill yourselves, instead. There would be more value in your existances.

I refuse to let my father see me and my dead corpse before me, so, I left him behind for that reason, too, with my entire family to protect them from your sick science that kills people for the use of their bodies.

Do you really believe you deserve to live?

First, what they do is pick you, usually, an ex of someone involved or connected to freemasonry charity fronted cia agencies. Next, they send Census unscheduled to your house. Next german Auschwitz and they destroy your economics, you suddenly become symptomatic of fake schizophrenia, and get a bunch of sick satanic trained, some with psychic abilities and other black magic and sorcery trained people hunting you down and hurting you constantly, destroying cars,destroying jobs, all so you can’t afford to protect yourself
from these midnight accessings of human experimented live
bodies. You can’t imagine how much pain is brought into our lives so you can succeed and IT IS NOT ACCEPTABLE!

Your entire existance and behavior to disregard what they do to obtain these human experiments IS NOT ACCEPTABLE BEHAVIOR.

You know what, fake schizophrenia fraud was created to CONTROL us victims from seeking the real criminal prosecution assistance and exposing the crimes you do to us…so it is there merely to destroy us, to help you commit crimes and atrocities to human life. Sick existance you have, trust me. I spit on all of you. You disgust me.

Oh by the way people, we human test rats are special and we do die of this crime to humanity all the time and you sit there and let them.

I hold you accountable for allowing it to occur.

Sick people, please, stop hurting and betraying your own people. It’s not right what you do. You don’t need to save lives by your experiments, you killed lives in sick ways. I am not sacrificing my life for anyone like you that is for sure… I deserved my life and my military, police, govt, universites and medical took it away from me because you pieces of crap do the job you do hurting us soooo deeply.

Burying us alive in our own hell created especially so you can do your work, is not acceptable to do. I curse you.

You sick people have entirely, painfully, destroyed my life through the use of freemason/cia charity fronted agencies, destroying my life. I had a promising future ahead of me. I was the kindest nicest person in the world. You destroyed my life and my future. Ten years of grave pain and suffering at your hands. God damn you all to bloody hell and destruction for the job you to to betray your own kind to get a paycheck and get ahead. You succeed on our bloodied backs and make damn sure you don’t forget or disregard our pain and great suffering from it. It is VERY PAINFUL AND WE ARE GOING TO DIE PAINFULLY BECAUSE OF YOU. Because…of….you.

I am the person who fought like bloody hell in grave poverty you placed me in and got that Pope New Canon laws to stop you, “NO HUMAN EXPERIMENTATION”, “NO GETTING TOO RICH”. Hear the cries of all the human sacrifices to your science that die every year at your hands, because you do this line of work. NEVER EVER Forget, while you are dining in fine restaurants or working in a lab and collecting paychecks driving nice cars, we barely have anything because you exist. We die, because, you exist. Oh, it’s for the sake of the future? What future? What good could come from this future of slow torture murder and fake schizophenia to hide your crimes to humanity.

Oh, I am very sure you thought this all out. I am most assured that you are the most sick people of all diluded to not pay attention to the small details of your success, as they lay dying and suffering and discarded. We are destroyed for life because of you poisonous sickened retards. You think you are so damn smart, I ask you, where is your brain? WHAT kind of beast would do this to their own kind? YOU! That’s who.

All I asked you to do was stop it and you continued.
You deserve this life, I do not and neither did two of my sweetest friends. You have no idea who they choose. They chose me, because I didn’t want to date an ex navy seal, naval assassinator trained, because he was caught in multiple lies, and dated 5 girls at the same freaking time and tried to kill me. I broke off dating him and he didn’t want anyone else to get me so he had me placed on this hitlist.

My girlfriends and I were some of the nicest people on this planet and what you did, was change all that. I am ashamed to be this close to you. I’m ashamed that you get to use my body as your tool. The sickest part about this, is I have been completely financially destroyed by the military and covens that are hired for black operations to help you pieces of crap.

Next, I go to fight for my rights to get free and they want to lock me, up? Me?! I have evidences and the police protocols keep me from proving your crimes to me via these street people. They hire gangs to help. Piece by piece, I have had entire cars totalled by your group, front and back. I have had complete destruction piece by piece, as I lose employments due to crazy crazy reasons. I move 1-2 times a year just to try to get one month of freedom from being harassed and abused by your street gangs working to help me keep from living well to defend myself from these crimes. I cry nearly every night from the pain and suffering of these groups that help you destroy my character so you can hide the crimes you do to humanity.

Can you live with yourselves? You have, so, I assume, we don’t matter. Well, we matter more than you. I will stop at nothing to become free and free my friends. It’s aweful funny how all three of my friends came down with the same purposely destroyed lives. I have enough evidence now to sink your ship, but, I promise you, when it sinks and it will, it won’t be from courts, as you and I know the entire system is based on fraud of justice and they would help you hurt your victims more.

So, yes, I’m the victim of your human betrayal and crimes and countless fraud protocols in the DSMIV to get anyone charged with mental illness and dilusional issues.

Well, people, I promise you this, I’m not done here. You are going to have to kill me because I’m going to bring you all to justice, even if my fingertips and flesh bleed clawing my way back out of the nasty painful life and living grave you put us in, alive, to do your sick human experiments on.

Try letting the living live instead of you people hurting them and destroying their lives. You don’t even want to know how they get little kids. They target people that are in poverty. Remove good parents from their kids and access them by ripping their good families apart. In America, you have to be really lucky not to become their victims. I promise you that.

I had a DOD and FBI clearance. I was doing well in life, just about to buy a house on the water and start enjoying life with my friends after working so hard to make it. You took all my dreams away by existing in the fashion you do.
You know how I became in poverty, running for my life trying to escape the black ops person who wouldn’t stop trying to kill me.

Thank you, for taking not only my life, but, countless other, friends of mine, and making a temporary pain, permanent and destroyed. While you receive awards and praise, remember, we are being demeaned, destroyed and told we are going to die every single day of our lives and even spit on, cursed and treated like crap, then, told we are imagining things and that no one will ever believe the truth. How’s that for a suck lifetime stolen by you. THIS is the reality of your success for us. You succeed, we endure pains you can’t fathom. They should be sending us the checks you get for what we endure. But, no, that would be just. Instead, we get destroyed and get to suffer purposeful pain inflictions for your tests using us. Slavery was a much better chance at life for us than this existance and shame on you for thinking this is acceptable. You are all the lowest forms of life for doing what you do to human life. For every successful thing you do, you torture and kill us good people with your betrayal to human life.

I hope you stop one day, when you wind up staring down at your own daughter’s corpse, the way my dying father will not get to. My father was the sweetest kindest most gentlest man. I won’t be there for him to say goodbye in his most frightened moment of his life: death…because you pieces of crap for life did this to me and it would kill him to know what was really going on (and imagine how horrible he’d feel if he was lied to and told that his daughter was mentally ill, just to hide your sick secrets) better he never knows me again…it will save him serious pains and suffering. If he ever knew what you sick people do to us, you would ruin any niceness that existed.

I never would have thought of hurting another human being and you do it so easily. You think you help people? You kill us to get your prize. Go kill yourselves, instead. There would be more value in your existances.

I refuse to let my father see me and my dead corpse before me, so, I left him behind for that reason, too, with my entire family to protect them from your sick science that kills people for the use of their bodies.

Do you really believe you deserve to live?

First, what they do is pick you, usually, an ex of someone involved or connected to freemasonry charity fronted cia agencies. Next, they send Census unscheduled to your house. Next german Auschwitz and they destroy your economics, you suddenly become symptomatic of fake schizophrenia, and get a bunch of sick satanic trained, some with psychic abilities and other black magic and sorcery trained people hunting you down and hurting you constantly, destroying cars,destroying jobs, all so you can’t afford to protect yourself
from these midnight accessings of human experimented live
bodies. You can’t imagine how much pain is brought into our lives so you can succeed and IT IS NOT ACCEPTABLE!

Your entire existance and behavior to disregard what they do to obtain these human experiments IS NOT ACCEPTABLE BEHAVIOR.

You know what, fake schizophrenia fraud was created to CONTROL us victims from seeking the real criminal prosecution assistance and exposing the crimes you do to us…so it is there merely to destroy us, to help you commit crimes and atrocities to human life. Sick existance you have, trust me. I spit on all of you. You disgust me.

Oh by the way people, we human test rats are special and we do die of this crime to humanity all the time and you sit there and let them.

I hold you accountable for allowing it to occur.

Sick people, please, stop hurting and betraying your own people. It’s not right what you do. You don’t need to save lives by your experiments, you killed lives in sick ways. I am not sacrificing my life for anyone like you that is for sure… I deserved my life and my military, police, govt, universites and medical took it away from me because you pieces of crap do the job you do hurting us soooo deeply.

Burying us alive in our own hell created especially so you can do your work, is not acceptable to do. I curse you.

You sick people have entirely, painfully, destroyed my life through the use of freemason/cia charity fronted agencies, destroying my life. I had a promising future ahead of me. I was the kindest nicest person in the world. You destroyed my life and my future. Ten years of grave pain and suffering at your hands. God damn you all to bloody hell and destruction for the job you to to betray your own kind to get a paycheck and get ahead. You succeed on our bloodied backs and make damn sure you don’t forget or disregard our pain and great suffering from it. It is VERY PAINFUL AND WE ARE GOING TO DIE PAINFULLY BECAUSE OF YOU. Because…of….you.

I am the person who fought like bloody hell in grave poverty you placed me in and got that Pope New Canon laws to stop you, “NO HUMAN EXPERIMENTATION”, “NO GETTING TOO RICH”. Hear the cries of all the human sacrifices to your science that die every year at your hands, because you do this line of work. NEVER EVER Forget, while you are dining in fine restaurants or working in a lab and collecting paychecks driving nice cars, we barely have anything because you exist. We die, because, you exist. Oh, it’s for the sake of the future? What future? What good could come from this future of slow torture murder and fake schizophenia to hide your crimes to humanity.

Oh, I am very sure you thought this all out. I am most assured that you are the most sick people of all diluded to not pay attention to the small details of your success, as they lay dying and suffering and discarded. We are destroyed for life because of you poisonous sickened retards. You think you are so damn smart, I ask you, where is your brain? WHAT kind of beast would do this to their own kind? YOU! That’s who.

All I asked you to do was stop it and you continued.
You deserve this life, I do not and neither did two of my sweetest friends. You have no idea who they choose. They chose me, because I didn’t want to date an ex navy seal, naval assassinator trained, because he was caught in multiple lies, and dated 5 girls at the same freaking time and tried to kill me. I broke off dating him and he didn’t want anyone else to get me so he had me placed on this hitlist.

My girlfriends and I were some of the nicest people on this planet and what you did, was change all that. I am ashamed to be this close to you. I’m ashamed that you get to use my body as your tool. The sickest part about this, is I have been completely financially destroyed by the military and covens that are hired for black operations to help you pieces of crap.

Next, I go to fight for my rights to get free and they want to lock me, up? Me?! I have evidences and the police protocols keep me from proving your crimes to me via these street people. They hire gangs to help. Piece by piece, I have had entire cars totalled by your group, front and back. I have had complete destruction piece by piece, as I lose employments due to crazy crazy reasons. I move 1-2 times a year just to try to get one month of freedom from being harassed and abused by your street gangs working to help me keep from living well to defend myself from these crimes. I cry nearly every night from the pain and suffering of these groups that help you destroy my character so you can hide the crimes you do to humanity.

Can you live with yourselves? You have, so, I assume, we don’t matter. Well, we matter more than you. I will stop at nothing to become free and free my friends. It’s aweful funny how all three of my friends came down with the same purposely destroyed lives. I have enough evidence now to sink your ship, but, I promise you, when it sinks and it will, it won’t be from courts, as you and I know the entire system is based on fraud of justice and they would help you hurt your victims more.

So, yes, I’m the victim of your human betrayal and crimes and countless fraud protocols in the DSMIV to get anyone charged with mental illness and dilusional issues.

Well, people, I promise you this, I’m not done here. You are going to have to kill me because I’m going to bring you all to justice, even if my fingertips and flesh bleed clawing my way back out of the nasty painful life and living grave you put us in, alive, to do your sick human experiments on.

Try letting the living live instead of you people hurting them and destroying their lives. You don’t even want to know how they get little kids. They target people that are in poverty. Remove good parents from their kids and access them by ripping their good families apart. In America, you have to be really lucky not to become their victims. I promise you that.

I had a DOD and FBI clearance. I was doing well in life, just about to buy a house on the water and start enjoying life with my friends after working so hard to make it. You took all my dreams away by existing in the fashion you do.
You know how I became in poverty, running for my life trying to escape the black ops person who wouldn’t stop trying to kill me.

Thank you, for taking not only my life, but, countless other, friends of mine, and making a temporary pain, permanent and destroyed. While you receive awards and praise, remember, we are being demeaned, destroyed and told we are going to die every single day of our lives and even spit on, cursed and treated like crap, then, told we are imagining things and that no one will ever believe the truth. How’s that for a suck lifetime stolen by you. THIS is the reality of your success for us. You succeed, we endure pains you can’t fathom. They should be sending us the checks you get for what we endure. But, no, that would be just. Instead, we get destroyed and get to suffer purposeful pain inflictions for your tests using us. Slavery was a much better chance at life for us than this existance and shame on you for thinking this is acceptable. You are all the lowest forms of life for doing what you do to human life. For every successful thing you do, you torture and kill us good people with your betrayal to human life.

I hope you stop one day, when you wind up staring down at your own daughter’s corpse, the way my dying father will not get to. My father was the sweetest kindest most gentlest man. I won’t be there for him to say goodbye in his most frightened moment of his life: death…because you pieces of crap for life did this to me and it would kill him to know what was really going on (and imagine how horrible he’d feel if he was lied to and told that his daughter was mentally ill, just to hide your sick secrets) better he never knows me again…it will save him serious pains and suffering. If he ever knew what you sick people do to us, you would ruin any niceness that existed.

I never would have thought of hurting another human being and you do it so easily. You think you help people? You kill us to get your prize. Go kill yourselves, instead. There would be more value in your existances.

I refuse to let my father see me and my dead corpse before me, so, I left him behind for that reason, too, with my entire family to protect them from your sick science that kills people for the use of their bodies.

Do you really believe you deserve to live?

First, what they do is pick you, usually, an ex of someone involved or connected to freemasonry charity fronted cia agencies. Next, they send Census unscheduled to your house. Next german Auschwitz and they destroy your economics, you suddenly become symptomatic of fake schizophrenia, and get a bunch of sick satanic trained, some with psychic abilities and other black magic and sorcery trained people hunting you down and hurting you constantly, destroying cars,destroying jobs, all so you can’t afford to protect yourself
from these midnight accessings of human experimented live
bodies. You can’t imagine how much pain is brought into our lives so you can succeed and IT IS NOT ACCEPTABLE!

Your entire existance and behavior to disregard what they do to obtain these human experiments IS NOT ACCEPTABLE BEHAVIOR.

You know what, fake schizophrenia fraud was created to CONTROL us victims from seeking the real criminal prosecution assistance and exposing the crimes you do to us…so it is there merely to destroy us, to help you commit crimes and atrocities to human life. Sick existance you have, trust me. I spit on all of you. You disgust me.

Oh by the way people, we human test rats are special and we do die of this crime to humanity all the time and you sit there and let them.

I hold you accountable for allowing it to occur.

Sick people, please, stop hurting and betraying your own people. It’s not right what you do. You don’t need to save lives by your experiments, you killed lives in sick ways. I am not sacrificing my life for anyone like you that is for sure… I deserved my life and my military, police, govt, universites and medical took it away from me because you pieces of crap do the job you do hurting us soooo deeply.

Burying us alive in our own hell created especially so you can do your work, is not acceptable to do. I curse you.

You sick people have entirely, painfully, destroyed my life through the use of freemason/cia charity fronted agencies, destroying my life. I had a promising future ahead of me. I was the kindest nicest person in the world. You destroyed my life and my future. Ten years of grave pain and suffering at your hands. God damn you all to bloody hell and destruction for the job you to to betray your own kind to get a paycheck and get ahead. You succeed on our bloodied backs and make damn sure you don’t forget or disregard our pain and great suffering from it. It is VERY PAINFUL AND WE ARE GOING TO DIE PAINFULLY BECAUSE OF YOU. Because…of….you.

I am the person who fought like bloody hell in grave poverty you placed me in and got that Pope New Canon laws to stop you, “NO HUMAN EXPERIMENTATION”, “NO GETTING TOO RICH”. Hear the cries of all the human sacrifices to your science that die every year at your hands, because you do this line of work. NEVER EVER Forget, while you are dining in fine restaurants or working in a lab and collecting paychecks driving nice cars, we barely have anything because you exist. We die, because, you exist. Oh, it’s for the sake of the future? What future? What good could come from this future of slow torture murder and fake schizophenia to hide your crimes to humanity.

Oh, I am very sure you thought this all out. I am most assured that you are the most sick people of all diluded to not pay attention to the small details of your success, as they lay dying and suffering and discarded. We are destroyed for life because of you poisonous sickened retards. You think you are so damn smart, I ask you, where is your brain? WHAT kind of beast would do this to their own kind? YOU! That’s who.

All I asked you to do was stop it and you continued.
You deserve this life, I do not and neither did two of my sweetest friends. You have no idea who they choose. They chose me, because I didn’t want to date an ex navy seal, naval assassinator trained, because he was caught in multiple lies, and dated 5 girls at the same freaking time and tried to kill me. I broke off dating him and he didn’t want anyone else to get me so he had me placed on this hitlist.

My girlfriends and I were some of the nicest people on this planet and what you did, was change all that. I am ashamed to be this close to you. I’m ashamed that you get to use my body as your tool. The sickest part about this, is I have been completely financially destroyed by the military and covens that are hired for black operations to help you pieces of crap.

Next, I go to fight for my rights to get free and they want to lock me, up? Me?! I have evidences and the police protocols keep me from proving your crimes to me via these street people. They hire gangs to help. Piece by piece, I have had entire cars totalled by your group, front and back. I have had complete destruction piece by piece, as I lose employments due to crazy crazy reasons. I move 1-2 times a year just to try to get one month of freedom from being harassed and abused by your street gangs working to help me keep from living well to defend myself from these crimes. I cry nearly every night from the pain and suffering of these groups that help you destroy my character so you can hide the crimes you do to humanity.

Can you live with yourselves? You have, so, I assume, we don’t matter. Well, we matter more than you. I will stop at nothing to become free and free my friends. It’s aweful funny how all three of my friends came down with the same purposely destroyed lives. I have enough evidence now to sink your ship, but, I promise you, when it sinks and it will, it won’t be from courts, as you and I know the entire system is based on fraud of justice and they would help you hurt your victims more.

So, yes, I’m the victim of your human betrayal and crimes and countless fraud protocols in the DSMIV to get anyone charged with mental illness and dilusional issues.

Well, people, I promise you this, I’m not done here. You are going to have to kill me because I’m going to bring you all to justice, even if my fingertips and flesh bleed clawing my way back out of the nasty painful life and living grave you put us in, alive, to do your sick human experiments on.

Try letting the living live instead of you people hurting them and destroying their lives. You don’t even want to know how they get little kids. They target people that are in poverty. Remove good parents from their kids and access them by ripping their good families apart. In America, you have to be really lucky not to become their victims. I promise you that.

I had a DOD and FBI clearance. I was doing well in life, just about to buy a house on the water and start enjoying life with my friends after working so hard to make it. You took all my dreams away by existing in the fashion you do.
You know how I became in poverty, running for my life trying to escape the black ops person who wouldn’t stop trying to kill me.

Thank you, for taking not only my life, but, countless other, friends of mine, and making a temporary pain, permanent and destroyed. While you receive awards and praise, remember, we are being demeaned, destroyed and told we are going to die every single day of our lives and even spit on, cursed and treated like crap, then, told we are imagining things and that no one will ever believe the truth. How’s that for a suck lifetime stolen by you. THIS is the reality of your success for us. You succeed, we endure pains you can’t fathom. They should be sending us the checks you get for what we endure. But, no, that would be just. Instead, we get destroyed and get to suffer purposeful pain inflictions for your tests using us. Slavery was a much better chance at life for us than this existance and shame on you for thinking this is acceptable. You are all the lowest forms of life for doing what you do to human life. For every successful thing you do, you torture and kill us good people with your betrayal to human life.

I hope you stop one day, when you wind up staring down at your own daughter’s corpse, the way my dying father will not get to. My father was the sweetest kindest most gentlest man. I won’t be there for him to say goodbye in his most frightened moment of his life: death…because you pieces of crap for life did this to me and it would kill him to know what was really going on (and imagine how horrible he’d feel if he was lied to and told that his daughter was mentally ill, just to hide your sick secrets) better he never knows me again…it will save him serious pains and suffering. If he ever knew what you sick people do to us, you would ruin any niceness that existed.

I never would have thought of hurting another human being and you do it so easily. You think you help people? You kill us to get your prize. Go kill yourselves, instead. There would be more value in your existances.

I refuse to let my father see me and my dead corpse before me, so, I left him behind for that reason, too, with my entire family to protect them from your sick science that kills people for the use of their bodies.

Do you really believe you deserve to live?

First, what they do is pick you, usually, an ex of someone involved or connected to freemasonry charity fronted cia agencies. Next, they send Census unscheduled to your house. Next german Auschwitz and they destroy your economics, you suddenly become symptomatic of fake schizophrenia, and get a bunch of sick satanic trained, some with psychic abilities and other black magic and sorcery trained people hunting you down and hurting you constantly, destroying cars,destroying jobs, all so you can’t afford to protect yourself
from these midnight accessings of human experimented live
bodies. You can’t imagine how much pain is brought into our lives so you can succeed and IT IS NOT ACCEPTABLE!

Your entire existance and behavior to disregard what they do to obtain these human experiments IS NOT ACCEPTABLE BEHAVIOR.

You know what, fake schizophrenia fraud was created to CONTROL us victims from seeking the real criminal prosecution assistance and exposing the crimes you do to us…so it is there merely to destroy us, to help you commit crimes and atrocities to human life. Sick existance you have, trust me. I spit on all of you. You disgust me.

Oh by the way people, we human test rats are special and we do die of this crime to humanity all the time and you sit there and let them.

I hold you accountable for allowing it to occur.

Sick people, please, stop hurting and betraying your own people. It’s not right what you do. You don’t need to save lives by your experiments, you killed lives in sick ways. I am not sacrificing my life for anyone like you that is for sure… I deserved my life and my military, police, govt, universites and medical took it away from me because you pieces of crap do the job you do hurting us soooo deeply.

Burying us alive in our own hell created especially so you can do your work, is not acceptable to do. I curse you.

You sick people have entirely, painfully, destroyed my life through the use of freemason/cia charity fronted agencies, destroying my life. I had a promising future ahead of me. I was the kindest nicest person in the world. You destroyed my life and my future. Ten years of grave pain and suffering at your hands. God damn you all to bloody hell and destruction for the job you to to betray your own kind to get a paycheck and get ahead. You succeed on our bloodied backs and make damn sure you don’t forget or disregard our pain and great suffering from it. It is VERY PAINFUL AND WE ARE GOING TO DIE PAINFULLY BECAUSE OF YOU. Because…of….you.

I am the person who fought like bloody hell in grave poverty you placed me in and got that Pope New Canon laws to stop you, “NO HUMAN EXPERIMENTATION”, “NO GETTING TOO RICH”. Hear the cries of all the human sacrifices to your science that die every year at your hands, because you do this line of work. NEVER EVER Forget, while you are dining in fine restaurants or working in a lab and collecting paychecks driving nice cars, we barely have anything because you exist. We die, because, you exist. Oh, it’s for the sake of the future? What future? What good could come from this future of slow torture murder and fake schizophenia to hide your crimes to humanity.

Oh, I am very sure you thought this all out. I am most assured that you are the most sick people of all diluded to not pay attention to the small details of your success, as they lay dying and suffering and discarded. We are destroyed for life because of you poisonous sickened retards. You think you are so damn smart, I ask you, where is your brain? WHAT kind of beast would do this to their own kind? YOU! That’s who.

All I asked you to do was stop it and you continued.
You deserve this life, I do not and neither did two of my sweetest friends. You have no idea who they choose. They chose me, because I didn’t want to date an ex navy seal, naval assassinator trained, because he was caught in multiple lies, and dated 5 girls at the same freaking time and tried to kill me. I broke off dating him and he didn’t want anyone else to get me so he had me placed on this hitlist.

My girlfriends and I were some of the nicest people on this planet and what you did, was change all that. I am ashamed to be this close to you. I’m ashamed that you get to use my body as your tool. The sickest part about this, is I have been completely financially destroyed by the military and covens that are hired for black operations to help you pieces of crap.

Next, I go to fight for my rights to get free and they want to lock me, up? Me?! I have evidences and the police protocols keep me from proving your crimes to me via these street people. They hire gangs to help. Piece by piece, I have had entire cars totalled by your group, front and back. I have had complete destruction piece by piece, as I lose employments due to crazy crazy reasons. I move 1-2 times a year just to try to get one month of freedom from being harassed and abused by your street gangs working to help me keep from living well to defend myself from these crimes. I cry nearly every night from the pain and suffering of these groups that help you destroy my character so you can hide the crimes you do to humanity.

Can you live with yourselves? You have, so, I assume, we don’t matter. Well, we matter more than you. I will stop at nothing to become free and free my friends. It’s aweful funny how all three of my friends came down with the same purposely destroyed lives. I have enough evidence now to sink your ship, but, I promise you, when it sinks and it will, it won’t be from courts, as you and I know the entire system is based on fraud of justice and they would help you hurt your victims more.

So, yes, I’m the victim of your human betrayal and crimes and countless fraud protocols in the DSMIV to get anyone charged with mental illness and dilusional issues.

Well, people, I promise you this, I’m not done here. You are going to have to kill me because I’m going to bring you all to justice, even if my fingertips and flesh bleed clawing my way back out of the nasty painful life and living grave you put us in, alive, to do your sick human experiments on.

Try letting the living live instead of you people hurting them and destroying their lives. You don’t even want to know how they get little kids. They target people that are in poverty. Remove good parents from their kids and access them by ripping their good families apart. In America, you have to be really lucky not to become their victims. I promise you that.

I had a DOD and FBI clearance. I was doing well in life, just about to buy a house on the water and start enjoying life with my friends after working so hard to make it. You took all my dreams away by existing in the fashion you do.
You know how I became in poverty, running for my life trying to escape the black ops person who wouldn’t stop trying to kill me.

Thank you, for taking not only my life, but, countless other, friends of mine, and making a temporary pain, permanent and destroyed. While you receive awards and praise, remember, we are being demeaned, destroyed and told we are going to die every single day of our lives and even spit on, cursed and treated like crap, then, told we are imagining things and that no one will ever believe the truth. How’s that for a suck lifetime stolen by you. THIS is the reality of your success for us. You succeed, we endure pains you can’t fathom. They should be sending us the checks you get for what we endure. But, no, that would be just. Instead, we get destroyed and get to suffer purposeful pain inflictions for your tests using us. Slavery was a much better chance at life for us than this existance and shame on you for thinking this is acceptable. You are all the lowest forms of life for doing what you do to human life. For every successful thing you do, you torture and kill us good people with your betrayal to human life.

I hope you stop one day, when you wind up staring down at your own daughter’s corpse, the way my dying father will not get to. My father was the sweetest kindest most gentlest man. I won’t be there for him to say goodbye in his most frightened moment of his life: death…because you pieces of crap for life did this to me and it would kill him to know what was really going on (and imagine how horrible he’d feel if he was lied to and told that his daughter was mentally ill, just to hide your sick secrets) better he never knows me again…it will save him serious pains and suffering. If he ever knew what you sick people do to us, you would ruin any niceness that existed.

I never would have thought of hurting another human being and you do it so easily. You think you help people? You kill us to get your prize. Go kill yourselves, instead. There would be more value in your existances.

I refuse to let my father see me and my dead corpse before me, so, I left him behind for that reason, too, with my entire family to protect them from your sick science that kills people for the use of their bodies.

Do you really believe you deserve to live?

First, what they do is pick you, usually, an ex of someone involved or connected to freemasonry charity fronted cia agencies. Next, they send Census unscheduled to your house. Next german Auschwitz and they destroy your economics, you suddenly become symptomatic of fake schizophrenia, and get a bunch of sick satanic trained, some with psychic abilities and other black magic and sorcery trained people hunting you down and hurting you constantly, destroying cars,destroying jobs, all so you can’t afford to protect yourself
from these midnight accessings of human experimented live
bodies. You can’t imagine how much pain is brought into our lives so you can succeed and IT IS NOT ACCEPTABLE!

Your entire existance and behavior to disregard what they do to obtain these human experiments IS NOT ACCEPTABLE BEHAVIOR.

You know what, fake schizophrenia fraud was created to CONTROL us victims from seeking the real criminal prosecution assistance and exposing the crimes you do to us…so it is there merely to destroy us, to help you commit crimes and atrocities to human life. Sick existance you have, trust me. I spit on all of you. You disgust me.

Oh by the way people, we human test rats are special and we do die of this crime to humanity all the time and you sit there and let them.

I hold you accountable for allowing it to occur.

Sick people, please, stop hurting and betraying your own people. It’s not right what you do. You don’t need to save lives by your experiments, you killed lives in sick ways. I am not sacrificing my life for anyone like you that is for sure… I deserved my life and my military, police, govt, universites and medical took it away from me because you pieces of crap do the job you do hurting us soooo deeply.

Burying us alive in our own hell created especially so you can do your work, is not acceptable to do. I curse you.